JULY 27 (AGENDA 1 – 3)
Agenda Item 1.3: Report of the Executive Director
Delivered by Elizabeth Glaser Pediatric AIDS Foundation
Thank you Chair.
We would like to thank Michel Sidibe for your report and the various comments on it.
We welcome the new operating model and strongly support the objectives UNAIDS selected to guide its implementation, including reinvigorating country-level joint work and collaborative action, and reinforcing accountability and results for people.
As an implementing partner, we count on UNAIDS and co-sponsors’ in-country leadership on policy, advocacy, and communications, as well as their role in convening stakeholders from the UN, government, and civil society.
The support of the PCB expressed today for the new model should also allow UNAIDS additional opportunity to invigorate global and country-level work on the Start Free, Stay Free, AIDS Free framework that Michel referenced in his report and which seeks to end HIV in children, adolescents and young women by 2020
The ambitious 2018 and 2020 targets in the framework were agreed due to the exceptional nature of pediatric HIV, such as the difficulties in quickly diagnosing babies and the rapid progression of the disease due to their immature immune systems.
We encourage UNAIDS and PEPFAR as the framework’s co-conveners, as well as UN agencies and NGOs to consistently and clearly engage with ministries and national stakeholders on the advantages of this new life cycle approach for women, children and adolescents affected by HIV; the urgent nature of the 2018 and 2020 targets; and the need to prioritize and ramp up activities to meet the new targets.
Finally, we like would to applaud the First Lady of Panama’s leadership and comments today against discrimination. She rightly described stigma and discrimination as immoral and offensive, and perhaps it is no more so than when directed at children. In all of our discussions of human rights and discrimination, and in the preparation of all of our guidance notes, briefs and other materials, the persistent and perverse stigma faced by children must be addressed.
We know we can end AIDS in children on the way to 2030 if and when we combine the tools, approaches, and collaboration with the communities that will get it done.
JULY 28 (AGENDA 4 – 8)
Delivered by Amina Nantanda from Uganda
My name is Amina, a 20 year old student of economics at Makerere University Business School in Uganda. I am a student leader, the coordinator of my University’s Anti AIDS club and a steering committee member of the Uganda Youth Coalition on Adolescent Sexual Reproductive Health Rights and HIV.
Chair and honorable dignitaries, I am coming from an environment where messages about cross-generation sex, relationships and abstinence no longer seem to make sense to me and most of my peers. Do you know why? At university just like in life, everyone deserves to live a good life including female students. A good hostel, nice meals perhaps some chicken and chips, a smart phone with facebook, instargram and whatsapp, have nice clothes as well as attain good grades. Do you know who can buy for me an Iphone 7 for example, its someone like you, not my age mate with whom we are at school with. Do we know their HIV status? The answer is no. How are we we supposed to know about safer sex when we have never been taught? How are we supposed to know our rights to our bodies when we are taught the only thing we have to offer in a relationship as young women is our bodies?
As a student leader therefore, I am concerned with this situation. When I see some of my peers dropping out of school due to unintended pregnancies, lose close friends to AIDS, and see some of my friends fail to finish university, I ask myself; who is responsible? Is it government, is it the UN, is it my parent, or it should be me? Please let me know.
Following the discussion of this PCB meeting, I realize that we have representatives of our governments, the UN people and the communities. My question then is, is there support for young women and girls in Uganda and many other African countries? If yes, how come it doesn’t reach our community organizations at grass roots? Many of us are in schools, where is the support for school health programs? Why is it difficult to discuss sexual health and relationships in school settings? Is it a crime to be an adolescent girl or young woman?
Ohh no, this is terribly wrong. You are failing us, you are failing my peers and you are failing our future. I am not sure what I am going to report back to my peers.
Who ensures that young women and girls are able to attain the best education and are able to lead meaningful lives as members of society? As a future economist, I can foresee economic retardation, dependency and failure.
We would love therefore, to see your involvement in community service the way you advocate for it during your meetings.
Please walk your talk!!
JULY 29 (AGENDA 9)
Panel 1. What is required for prevention scale up?
Delivered by Mary Ann Torres, ICASO
My name is Mary Ann Torres, executive director of ICASO, based in Toronto, Canada. You have heard over the last two days here – and perhaps over the last few months in the press about the humanitarian crisis in my home country of Venezuela.
This is a crisis of many facets, but it is above all humanitarian: people are dying of hunger. People are dying of preventable, treatable infections. Our friends living with HIV are dying of AIDS.
Let me summarize the situation borrowing the words of journalist Stephanie Nolen: there is nowhere in the world today where people are dying of AIDS at the pace and in the sheer numbers that they are in Venezuela.
As we are in the thematic session on prevention, let me focus on the current situation of prevention efforts in the country:
- There are at least 300.000 people living with HIV. There are at least 11.000 new infections every year. In 1999, 1242 people died of AIDS-related complications. In 2015, that number more than doubled.
- There are no condoms or lubricants
- Shortages in medical equipment have meant recycle and reuse (including needles, test tubes, etc), regardless of the risk of disease transmission.
- There is no diagnostic or monitoring tests
- Women living with HIV are not able to prevent mother to child prevention
- People are dying daily of TB, hepatitis and toxoplasmosis and other opportunistic infections. There is no treatment for hemophilia. People are dying of diarrhea because there are not fluids to treat it.
- Stock outs of ARVs have been going on for months, with 70% to 90% of treatment absent from the distribution chain. 80% of people living with HIV are without treatment today, and they will be until at least end of August.
- In 2011, a study revealed that 10% of the WARAO population (indigenous ethnic group in the northeast of the country) were living with HIV. Further research has determined that this may have doubled by now.
We urge UNAIDS, its co-sponsors, its partners and the allies around this room to respond to this humanitarian crisis, looking beyond the limitations of policies, politics and income classifications. We ask you to look beyond the government’s reports and data and to invest – yes, invest resources- in strengthening community systems in particular to get the most accurate information about the crisis. This is what ICASO is currently doing with our partners in Venezuela. We ask that you continue facilitating and start providing immediate concrete assistance.
We need resources to buy commodities, we need political support. We need you to be ready to act when the humanitarian emergency is declared. We need a longer-term strategy to build our health and community systems. We ask you to talk to Venezuelan doctors, activists, people living with HIV and to listen to what they need – and to act, now!
Delivered by Maria Godlevskaya, EVA
Is there anyone here who is doubtful that non profit organizations work effectively with high risk groups?
THE WORLD HEALTH ORGANIZATION AFFIRMS THE SIGNIFICANT ROLE OF NON PROFITS IN WORKING WITH VULNERABLE GROUPS.
I HAVE BEEN LIVING WITH HIV FOR 18 YEARS AND I AM HERE TODAY THANKS TO NON PROFITS.
These are not just words: I am not dead and I am here with you today thanks to outreach work which was done – and continues to be done – by people from the community.
The network of women living with HIV, EVA, conducted research on the access of non profit organizations to federal resources to work on preventing HIV among vulnerable groups.
We had a hypothesis that we wanted to either confirm or refute. The hypothesis was that the federal funds to prevent the spread of HIV did not correspond to the rate of the epidemic’s growth and that it barely gets into the hands of non profits. As before, the drivers of the rise in the epidemic in 50% of cases are IDU, MSM, and SW (injection drug users, men who have sex with men, and sex workers). Meanwhile, the federal funds are dispersed at best in a ratio of 80% to 20% (поделить зал для наглядности на группы риска).
Our government recognizes the importance of non profits’ contribution to working with high risk groups.
Our research showed that:
- Among the federal resources geared at preventing HIV, a mere 5.24% (five point two four percent) of resources were received by non profits. The good news is that within these 5%, 76% implemented programs aimed at MSM, SW, IDU, and PLWH. These numbers won’t increase unless the share of the budget allotted for non profits working with key groups is determined. And it must reflect the tendency of the epidemic’s development.
- Last year, 41 times more recourses were spent on video clips and television programs than on outreach, counseling, and case management work combined, which are the key methods of working with IDU, MSM, and SW.
- In 2016, mechanisms to support non profits appeared however HIV service non profits specifically have many barriers to accessing them. For example, barriers to accessing social services in Russia include the obligation to officially recognize the person in need. Imagine how it would be if outreach workers demanded drug users show their passports, pension identification and proof of salsry before providing services.
- In order to take part in contests or receive subsidies, non profits must have working capital but not one bank gives loans to non profits. The regulations must be changes or advance payments or repayment in stages must be permitted.
- Besides this, there are regions that leading in HIV. They need all available resources to be directed to the prevention of HIV, and not only federal resources, but also money given directly to support non profit organizations that make HIV prevention a priority.
- We need to negotiate with the Ministry of Health – we need to work together to strengthen the participation of civil society and the community in prevention work – we need to overcome barriers – and develop the long-term three-year HIV prevention programs
Panel 2: How to Reach those at risk with programmes and services
Delivered by: Robin Montgomery, Interagency Coalition on AIDS and Development (ICAD)
I’m with the Canadian-based Consortium, the Interagency Coalition on AIDS and Development (ICAD).
Thank you very much to our esteemed panelists and to the working group who have organized today’s very important thematic segment.
One issue we haven’t heard about today – but yet constitutes a key driver of new infections around the world – is the growing level of HIV complacency. Complacency, mutes urgency and furthers embeds the false perception that AIDS crisis is over. Complacency is one of the strongest barriers impeding access to HIV testing and knowing one’s status. It threatens and stifles political will. And it consistently works against our best efforts to reach and exceed our 2020 targets.
HIV is far from over.
So, as a question to all our panelists – and in fact as a question to all of us in the room – in the context of taking prevention to scale – what needs to happen to prevent and stem the growing tide of HIV complacency? Should we be rethinking the mantra “the end of AIDS” when complacency has become a risk factor for leaving key and vulnerable populations behind including migrants, Indigenous Peoples, and prisoners?
Delivered by Yana Panfilova, EECA Adolescent Network Teenergizer!
My name is Yana, I’m 19, and I was born with HIV. I am from Ukraine. I represent Eurasian Union of adolescents and youth Teenergizer and Y+.
Teenergizer is an organization created by teenagers for teenagers. We build a world where each teenager can realize her or his full potential; a world that is free of discrimination of any kind, including life with HIV;
Unfortunately, HIV epidemic is growing among general population in our region. In Ukraine in 2016 there were 129,000 adolescents aged 10-19 years old at risk of HIV infection. Compared to 2015, this number increased by 5500 adolescents. The conclusion – the situation is getting worse.
At the moment, there are 2 main challenges for HIV prevention among adolescents in Eastern Europe and Central Asia.
The first one is barriers in access to HIV testing. Unfortunately, not all adolescents have the access. This problem is related to age and parental consent, cost of HIV testing (it is not always free), access to express testing and access to youth-friendly services.
Another challenge in our region is the lack of quality information about HIV and Sexual and Reproductive Health at schools. In some countries, there is no SRH education. Sometimes information that is provided to us by teachers about HIV and SRHR is based on their own stereotypes.
As you known we, young people, don’t have money. Condoms are very expensive for us. Access to free condoms is very important for us.
These two problems need to disappear as soon as possible because only by solving them there is an opportunity that the epidemic will stop not only in my region but all across the globe.
Delivered by Sasha Volgina, All-Ukrainian Network of People Living with HIV/AIDS
Какие основные барьеры в том, чтобы на деле на земле расширить профилактические программы и сделать их наиболее эффективными?
Низкий уровень финансирования. В моем регионе большая часть средств тратиться на АРВТ – потому что высокие барьеры интеллектуальной собственности рождают высокие цены, – снижение цен на АРВТ высвободит большое количество ресурсов. И слава Богу правительства стран и сообщества в регионе начинают все эффективнее, а порой и совместно работать в этом направлении. Если мы снизим стоимость лечения, появятся деньги, которые могут быть использованы для развития профилактики.
Много мы сейчас говорим об оптимизации лечения – это целый вектор. Но на наш взгляд есть возможность «оптимизировать» профилактику. Чем меньше стигма, дискриминация и криминализация ключевых групп – тем легче их достигать, тем меньше в денежном эквиваленте весят профилактические интервенции. Декриминализация сообществ (ЛГБТ, ЛУН, секс работников) искоренение дискриминации – делает профилактические интервенции простыми в реализации и ДЕШЕВЫМИ. В новом гранте ГФ Украина заложила средства на авдвокацию прав и декриминализацию сообществ – силами самих сообществ – потому что мы верим, в то, что только так мы сможем на деле достичь всех, кто в этом нуждается.
Государства находятся в стадии перехода и только начинают расходование бюджетных средств средств на программы по ВИЧ и на профилактику, это не простой и не гладкий процесс, именно поэтому, нам сообществам необходимо освоить мониторинг расходования средств и бюджетную адвокацию. Как говорили и будут еще говорить сегодня мои коллеги из стран нашего региона – у нас большие трудности в получении государственного финансирования для работы с уязвимыми группами и в обеспечении перехода созданных донорами систем на государственное финансирование. Но у нас есть положительный опыт – в прошлом году Всеукраинская Сеть в партнерстве Центром Общественного здоровья смогли проадвоктировать государственное обеспечение программ Заместительной терапии. Заместительная Терапия в Украине в полном объеме будет в этом году закуплена за средства национального бюджета. Мы очевидно видим, что в странах где сообщества, гражданское общество и государство работают совместно – есть переговорные процесс, адвокатирование и участие сообществ – этот процесс перехода проходит быстрее и успешнее.
Расширение программ профилактики в нашем регионе возможно при условии высвобождения средств бюджета за счет сокращения стоимости лечения, повышения эффективности самих программ – за счет декриминализации, и обеспечения расширения участия государства в реализации программ по профилактике в том числе для уязвимых групп – путем мониторинга, этого перехода, бюджетной адвокации – и переговоров и совместной работа государства и организаций сообществ.
Delivered by Kath Khangpiboon, Asia Pacific Transgender Network and Founder of Thai Transgender Alliance
Globally, it is estimated that around 19% of transwomen are living with HIV. In fact, transgender women are 49 times more likely to be living with HIV than the general population. The vulnerability of transmen to HIV remains under studied.
Despite these heightened risks, relatively few HIV programmes or services are tailored to the needs of trans populations. Trans populations tend to be included under programming for MSM, which deprioritises trans people’s unique needs.
We need to promote various testing strategies to reach trans populations. HIV counselling and voluntary testing for HIV and other STIs should be offered routinely to trans people, both in community and clinical settings. HIV pre- and post-test counselling for trans clients should take into account trans-specific risk factors and cofactors. In addition, community-based HIV testing for trans populations should be made available. Trans people who screen HIV negative but report high levels of HIV risk may be eligible for HIV pre-exposure prophylaxis (PrEP) to block the acquisition of HIV.
We need to address the root cause of leakage in care cascade for trans populations. The HIV services cascade is based on the assumption that successful HIV programming requires strong linkages between prevention, care, and treatment components. Research in recent years has documented the lack of interconnectedness between these various intervention components and the resulting losses to follow-up. These losses are greater across the cascade for trans people than amongst the general population. They are exacerbated amongst trans subpopulations, including trans sex workers, drug users, and youth.
Most importantly, trans-led services are the key component of comprehensive services that need to be promoted and scaled-up. An array of environmental, structural, and community- and individual-based interventions are required to ensure that trans people can access HIV services that do no harm and are sensitive to trans health and HIV needs. Trans community can serve as peer navigators who help to collect personal data, provide general information about the functioning of the service, and motivate their communities to take advantage of certain interventions (e.g., Hepatitis B vaccine, HIV testing, anal examinations, self-support groups, etc.), as well as provide peer education and support and further linkages to care. We need to address human rights-, stigma-related and other structural barriers to services for trans communities. All these services should be part of a comprehensive and integrated programme of services ensuring that trans people have early and sustained access to targeted HIV prevention, care, and treatment services.
Finally, we need to put trans-populations at the center of HIV programming and allow for the services to be differentiated for sub-populations within the trans communities. Success in reaching and retaining trans populations in care is determined by the ability of the HIV program to take into account the specific vulnerabilities of diverse communities in the trans populations. This includes adolescent and young trans populations, trans people who sell sex, use drugs and those in closed settings. For instance, the research shows that a number of transgender women sell sex in many parts of the world, including in Asia – where I am from. Power differentials between clients and trans sex workers often put transwomen at risk, esp. in cases where clients offer more money to have unprotected sex. Trans women and men may feel at a disadvantage in negotiating sexual practices and prevention behaviours because they perceive a shortage of partners willing to enter into a committed relationship. The desire to conform to specific cultural beliefs and practices around gender roles may also contribute to heightened sexual risk. Like other at-risk populations, research has shown that for trans women, unprotected sex is most likely with noncommercial primary partners.
Finally, governments must invest more to HIV prevention service. In the 2016 Political Declaration, Member States committed to at least a quarter for prevention.
Delivered by Nadia Rafif, The Global forum on MSM and HIV (MSMGF)
My name is Nadia RAFIF. I am the director of Policy of the Global Forum of MSM and HIV (MSMGF), after having directed an NGO working with Key populations, especially Gay and bisexual men and other men who have sex with men in the MENA region. The Global forum on MSM and HIV (MSMGF), the organization I belong to, convenes early 2016 a Global Advocacy Platform to Fast Track the HIV and Human Rights Responses with Gay & Bisexual Men, composed on activists, researchers, multilateral representatives, and donors, to provide guidance to UNAIDS and coordinate action at multiple levels. One area of interest was to ensure that combination prevention, treatment, and holistic sexual health programming is modernized and relevant for gay and bisexual men. So, thank you to have dedicated this day to prevention, the heart of the early battle against the epidemic. But where are we now?
If we look at the global trend for HIV infections over the past 15 or so years, new infections were in decline from 2000-2010 and have not decreased much from 2010 to now. Morever, Gay and bisexual men and other men who have sex with men are among the small number of groups for whom HIV remains uncontrolled worldwide. Prevalence and incidence is consistently higher or rising among men who have sex with men when compared with other groups. I am then surprised not to have heard clearly here Gay and bisexual men and other men who have sex with men as a high priority group during the presentation this morning (nor in the UNAIDS Background note), in every country and not only in the 33 prioritized ones. Prevention is the heart of the battle: so why it is not working? I worry as well, as this morning, we have not heard enough the word sexuality while talking about prevention? So let’s talk about sex, and pleasure. All sexual health and HIV programming should emphasize a holistic approach to wellbeing that embraces pleasure and endorses harm reduction. If we are not able to talk about sex, it wont work.
If we examine prevention programs done at scale, we will also discover that the programs were not/are not comprehensive. Moreover, we would likely discover divestment trends in prevention as the world discovered the powerful effects of ART. Sadly, a deeper dive into funding trends and behind what governments call ‘prevention’ would reveal strong correlations between flat incidence, flat funding, and deflated programming. The love affair with the idea that we could throw pills at people to make the AIDS epidemic needs to go away let policy makers and donors off the hook from understanding prevention dynamics more fully, including the need for differentiated, comprehensive responses, tailored to key populations.
Flat incidence signals the possible limits of test and treat-focused strategies. In other words, it is possible that ART-dominant AIDS responses are effective in diminishing AIDS deaths but have a ceiling in its prevention impact.
As new prevention and treatment technologies are introduced and popularized, the Platform insists that community members are adequately consulted and included to ensure relevance and effectiveness. Global leaders must adopt a differentiated and bolder HIV response that is evidence-based, community-led, and human rights-affirming for gay and bisexual men. The HIV response must offer a combination of prevention and treatment options to that maximizes choice and respects autonomy for all gay and bisexual men. This includes prevention campaigns that are inclusive of both condoms and PrEP, and treatment options that provide comprehensive care and support. HIV should be integrated within the broader sexual health needs of gay and bisexual men which takes into account the psychosocial and structural factors that heighten health vulnerability, including heightened risk for HIV. (Ie the Sexual health center for gay and other men who have sex with men in Marrakesh, Morocco (described in the UNAIDS background paper) I helped to establish in Morocco which addresses not only HIV counselling and testing and STI diagnosis, but also mental care and psychosocial support, and now PreP.) FOR THIS TO WORK, All services must be non- judgmental, sex-affirming, free from stigma and discrimination, honor self-determination, and respect bodily autonomy. •Individuals should feel empowered to exercise the right of choice for sexual health and services.
The HIV response will fail gay and bisexual men if their specific needs are not addressed directly and explicitly in programming. I hope the world will realize soon there is no such thing as ‘generalized epidemics’, and then see the birth of political/funding retrenchment with loud announcements about the end of AIDS. We still need, more than ever, a prevention revolution.
Universal Health Coverage
Finally, we need to speak about the trend towards universal health coverage (UHC) and what it means for the HIV response. In particular, the trend towards integrating disease programs instead of continuing to have stand-alone programs for HIV. UNAIDS should help the global HIV community understand what the implications of UHC are on the HIV response. How might funding allocation decisions be different? How might service delivery models be different? How would community systems strengthening work? Etc. In particular, the implications of these shifts on Key Populations programming would be very important to understand as the transitions happen. If/as UHC expands as the global approach, having “community” deliver there in is critical.
Delivered by Mat Southwell, Drugs Civil Society
I am speaking as the Secretariat of the Drugs Civil Society Group, a mechanism linking 20+ global and regional harm reduction, drug policy and drug user networks with UNODC as the co-sponsor for people who use and particularly inject drugs and people in prison. The Secretariat is funded by UNODC Global HIV Programme reflecting the strong and sustained partnership that has developed between drugs/HIV networks and UNODC over the last five years. We have a robust and accountable relationship which is coordinated through an annual work-plan and face-to-face meeting alongside CND each March.
We appreciate the challenges of managing the shortfall between the budget allocated for UBRAF and the funding mobilised from member states. We appreciate the detailed negotiations that have taken place between different stakeholders to arrive at the new operation I guess model. We understand that there has been a desire to move to a consistent and coherent model between the Secretariat and the Co-sponsors. However we remain unconvinced by the argument that all co-sponsors should receive the same investment regardless of their work-load.
We also understand that arguing for the exceptionalism of any one affected population undermines the important principle that key populations should operate in a mutually supportive manner and that no-one should be left behind. However we would be remiss as drugs/HIV advocates if we did not highlight that the global community missed the MDG target for reducing new HIV infections among PWID by 33%. The context for the drugs/HIV response remains dramatically impacted by drug control and we recognise the important sensitising role that the UNODC Global HIV Programme has within the wider UNODC organisation, which includes being ahead of the curve in civil society engagement.
People who use drugs face a disturbing escalation in anti-drug user discrimination, whether this is based on undermining harm reduction by forcing drug users towards abstinence, the denial of the science supporting harm reduction by Government’s who persist with models that do not comply with the science or human rights standards, forced detoxification and coerced treatment, and the state encouraged murder of people who use drugs in the Philippines.
We are particularly worried at the lack of alignment between the UNODC High Priority Countries and the UNAIDS Fast Track Countries – a concern expressed by Portugal and UNODC who we align our comments with. HPC’s are negotiated with the Drugs CS Group and we remain concerned the growing epidemics among people who inject drugs in Eurasia, Asia and increasingly Africa fall outside the UNAIDS priorities. We will be looking closely at how the country envelopes are used in these countries to galvanise change and also particularly to support civil society partnerships.
In the midst of a meeting where there is a desire to find consensus and a way forward, we give notice that we will be watching closely the implementation of the new operational model and the supporting accountability framework provided by UBRAF, to see how the global community will respond to the escalating HIV epidemics among people who use drugs around the world against an increasingly harsh and challenging backdrop.
Delivered by Jonathan Gunthorp, South African AIDS Trust (SAT)
I speak on behalf of the Southern African AIDS Trust (SAT), a partnership of over 30 NGOs and CBOs in Eastern & Southern Africa.
I come from a country where every week 2400, mostly girls and young women, contract HIV, and where in a recent 51 day period 60 women were murdered in just one of our nine provinces in what has become an unprecedented epidemic of femicide.
Moderator, over the last ten years we have combined prevention, we have revolutionized it, reinvented it, & reinvigorated it. We have also underfunded, undervalued, and over-medicalized it.
What we have not done is succeed with it.
So when I’m faced with these disturbingly cheerful prevention balloons and I do not see a balloon and a target for ‘Gender Equality’; I do not see a balloon and a target for ‘GBV’; I do not see a balloon and a target for integration with SRHR; and I do not see a balloon and a target for ‘Keeping girls in safe schools, or for removing legal barriers to adolescent access to health services, amongst many other missing balloons, I worry.
I understand the decision to focus on primary prevention. Yet every time we do so, we send signals that structural issues are not real prevention; we inadvertently over-emphasise medicalized modes of prevention; and we abdicate just a little our leadership of broader prevention.
I worry that whatever we call this new reincarnation of prevention, if it does not ‘look up’ and move from rhetoric to reality of integration into the broader SRHR and gender equality agendas of SDGs 3 & 5, then this prevention – much like the overall HIV response, and much like all of us in this room – is in danger of becoming self-referencing, self-absorbed, and by-passed by the global development agenda.
I hope that connecting the dots makes us look up. I hope that connecting the dots keeps prevention as a broader concept. I hope that the dots we connect will integrate prevention into the broader development agenda. I hope too that the dots lead us to put aside our agency interests and our introspection, and put people living with HIV, girls, and key populations at the core of a truly people-centred prevention.
I hope someone in this room can assure me that we will.